Here’s @vivekgaripalli on @CloverHealth’s role in the future of healthcare 🍀

See my original post on LinkedIn: https://t.co/lohUOVDP5X #Healthcare #Personalization #Software

That’s where #CloverAssistant comes in – delivering personalized, data-driven care recommendations that can scale at the speed of software – allowing every person to be treated like an individual instead of the average of a whole. @CloverHealth $CLOV

It’s mind blowing that doctors are blanket-prescribing drugs just to get higher scores on population health metrics, but unfortunately they are rewarded for box-checking at the cost of customized targeted care

What’s even crazier is that the doctor’s unnamed health system will receive higher star ratings (which leads to increased revenue, prestige and enrollment) based on doing the WRONG thing for my friend

To maintain his quality scores, he NEEDS her on these drugs, despite the fact that they are not necessarily medically appropriate for her

Why is he still pushing prescriptions? Because on average this is the right decision for someone with her disease burden, and for his population health quality metrics, that trumps her individual needs

However, her doctor (at a very popular verticalized healthcare system in California that will remain unnamed) is constantly pressuring her to take metformin and a statin, even though in her case, her chronic disease is being managed through lifestyle changes

A friend of mine, a black woman, has Type II diabetes. She’s very responsible when it comes to managing her condition and has improved her diet to control her A1C

Here’s an example of where #ValueBasedCare based on population health breaks down...

That obviously won’t work. Every person has unique needs, which require personalized attention and care. While it seems like a no-brainer, the challenge here is that this level of care is very hard to scale. Hence why the industry has settled for population health

I like the spirit of #PopulationHealth but I hate the way it’s worded. Why? It sounds like it endorses managing health at the “population” level, aka treating each individual like the average of the whole

Helping more PCPs participate in #ValueBasedCare (aka SUPPORTING the ones that are already HERE and caring for patients) will help create equity in the system. Period. That’s what we’re working to do at @Clover Health $CLOV

Open, inclusive networks are essential for health equity. So I continue to ask myself…why are we okay with letting narrow networks dominate the insurance landscape?

Rather than ‘othering’ these doctors to exacerbate the already critical PCP shortage and generate even more barriers to care for the patients they serve, why aren’t payors working to support them?

This forces their patients - again, those in higher need communities - to have to choose between #insurance they can afford and sticking with the doctor they know and trust. As far as advancing #HealthEquity…well. It’s obviously not good

Why? Because they’re typically more overburdened, have fewer resources, and have to see a higher volume of patients every day (and spend less time with each) than doctors in more advantaged areas

Why is that? The quality metrics used by health plans to determine whether a PCP is ‘high-performing’ or ‘low-performing’ (aka whether they’re ‘good’ enough to be included in their narrow network) tend to penalize doctors that fall into this bucket

But the consequence (while not necessarily intentional) is that the PCPs who get excluded from this narrow-network club are generally the ones servicing lower-income and #underserved communities

The reason payors do this is generally because it’s better for profitability to work w/ fewer doctors. Okay, understandable.